Provider Demographics
NPI:1932209061
Name:GLASSON, CYNTHIA LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:GLASSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2358
Mailing Address - Country:US
Mailing Address - Phone:248-391-9090
Mailing Address - Fax:248-391-9210
Practice Address - Street 1:3003 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2358
Practice Address - Country:US
Practice Address - Phone:248-391-9090
Practice Address - Fax:248-391-9210
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICG011459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI107505OtherCARE CHOICE
MI1982630612Medicaid
MIC6279OtherM-CARE
MI010000827OtherHEALTH PLUS
MI3364670Medicaid
MI5631225OtherBCBS
MI1982630612Medicaid
MI3364670Medicaid
MI0P01430Medicare ID - Type Unspecified